MEDICARE: KEISHA D WARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	P016179	NC

General Provider Information

NPI Number	:	1609710052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA D WARD

Provider Business Mailing Address
First Line	:	11361 N 99TH AVE STE 402
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-5459
Country	:	US
Telephone Number	:	602-650-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1827
Country	:	US
Telephone Number	:	919-975-5396
Fax Number	:	919-975-5397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ KEISHA D WARD ” Practice Location

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